Comprehensive neuromuscular profiler

ABSTRACT

A Comprehensive Neuromuscular Profiler (CNMP) allows the observation of human and equine muscle functionality and characteristics. The CNMP consists of an integrated system which combines EMG technology, electromagnetic range-of-motion (ROM) technology, and functional capacity sensors. Output signals from the devices are digitized and stored in computer memory. The data may be transmitted to a server computer for further analysis. The server computer examines the data to determine patterns and consults an expert database to determine a diagnosis based on the patterns and combinations of patterns detected.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 60/485,979 filed on Jul. 9, 2003 entitled ComprehensiveNeuromuscular Profiler.

FIELD OF THE INVENTION

The Invention relates to the collection of data for an expert diagnosticsystem, and more specifically, to the collection of data for acomprehensive neuromuscular profiler for monitoring general muscularstatus and assessing muscle and soft tissue injuries. The Invention isan integrated biomechanical information gathering and expert analysissystem for evaluating health and functioning of human muscles and thejoints operated by the muscles.

DESCRIPTION OF THE RELATED ART

The range and dynamics of motion of a patient, the strength of thepatient's muscles and the electrical characteristics of the musclesprovide information useful to a clinician making treatment decisions fora patient. The same information also may be useful to determine theexistence, severity or cause of an injury and whether an injury is acuteor chronic for purposes of determining questions of insurance or otherliability.

Soft tissue injuries and pathology may occur in any area of the body andmay include repetitive stress injuries, injuries to muscles, myofascialinjuries, damage to vertebral disks, radiculopathy, and others. Theseinjuries may be difficult to diagnose and hence may be difficult totreat properly.

Electromyography (“EMG”) has proved to be useful in diagnosing someinjuries, especially those that are related to repetitive motion. Moregenerally, EMG is useful in diagnosing injuries which can be identifiedfrom the examination of static muscle activity. However, EMG cannotprovide a comprehensive examination of muscular compensation patterns.These patterns are a key aspect of identifying and properly diagnosingmyofascial injuries.

Range-of-motion (“ROM”) testing has also been used to identify injury byexamining the characteristics of dynamic muscle activity. However, likeEMG testing, ROM testing has limitations in providing a full examinationof compensation patterns, and is not adequately effective as astand-alone method for injury diagnosis.

There have been attempts to integrate EMG and ROM technology to providea more comprehensive diagnosis process.

SUMMARY OF THE INVENTION

The Invention integrates several muscle and joint monitoringmeasurements into a single apparatus so that an expert diagnosis may beprovided based on the data collected by the apparatus. The apparatusgathers four types of information, which may be collected simultaneouslyor serially: motion, video, muscle capacity and electromyography(“EMG”).

Motion information is collected by remote sensing technology. A suitabletechnology is pulsed DC magnetic field sensing, although other sensingtechnologies such as optical sensing or AC magnetic field sensing may beused. In pulsed DC magnetic field sensing, an electromagnetictransmitter generates a pulsed electromagnetic field. One or more ROMsensors, each comprising three axis ring-core flux-gate magnetometer,are attached to the patient. Changes in the electromagnetic field aredetected by the ROM sensors. The detected changes in the electromagneticfield are measured and analyzed by a ROM signal processor, whichtranslates the ROM signal from the ROM sensors into information definingthe position and motion of the ROM sensors and hence of the patient. Themotions measured include the range of motion (“ROM”) and also mayinclude the dynamic motion of the patient within the ROM.

Muscle strength measurements are collected by having the patient exertforce using the muscle in question against a fixed object and measuringthe force exerted by the muscle. Grip strength, finger pinch strengthand isometric functional test measurements are made by having thepatient grip, pinch or otherwise exert force on the appropriate sensors.EMG measurements are collected by attaching electrodes (referred to inthis application as “EMG sensors”) to the patient and recordingelectrical activity of the muscles in question.

The signals collected from the various sensors are digitized andrecorded in the memory of a client computer. The client computer maycommunicate the data to a server computer over a computer network.Software resident in the server computer includes an expert system thatevaluates the data for patterns and for combinations of patterns amongthe types of data collected. The server computer is programmed tocompare the patterns, or lack of patterns, detected in the data topredetermined patterns associated with injuries, pathologies, and lackof injuries and pathologies. The expert system may diagnose, forexample, sprains, strains, vertebral disk injury and radiculopathies.The expert system also may determine whether the injury is of recentorigin, thereby distinguishing acute from chronic injury. The expertsystem may look for changes in other muscles or behaviors compensatingfor pain or loss of use as the result of pathology or injury. An issuewith the interpretation of EMG results historically has been thevariability in interpretation among different healthcare professionals.The expert system serves to resolve that variability and to achieveconsistency of interpretation. The server computer assigns a patientprofile to the patient based on the diagnosis made by the servercomputer. The server computer may communicate the patient profile to theclient computer for display to the user. Alternatively, the patientprofile may be communicated to any other authorized person. Thefunctions of the client and server computers may be integrated into asingle stand-alone computer.

The client computer is programmed to administer any of several“protocols” to the patient and to record the resulting data. A“protocol” is a sequence of tasks, or tests, that the patient performswhile the appropriate sensors collect data concerning the portion of thepatient's body in question. Each protocol specifies the identity, numberand location of the sensors to be used. The client computer isprogrammed to provide step-by-step instructions to the patient and tothe technician, or user, administering the protocol to the patient. Theclient computer is programmed to collect and record the appropriatesensor data for each protocol. For purposes of this application, thespecific data specified to be collected for a particular protocol isreferred to as “protocol data.”

As used in this application, the term “client computer” means anycomputer or system of computers capable of communicating with anothercomputer over a computer network. The term “server computer” means anycomputer or system of computers that is capable of receiving acommunication over a computer network from a client computer andperforming an evaluation based on the received communication.

The apparatus may be equipped with automated, interactive instructionsto an operator who has no or little knowledge of anatomy. The apparatustherefore may be operated at a relatively modest cost. The apparatus maybe equipped with a video carmera or other remote imaging technology toallow a physician or other medical personnel to remotely monitor theprocedure and to create a visual record of the tests performed and thepatient's response to the tests. The apparatus may be equipped with thecapacity to automatically generate billing forms or electronic files,such as the HCFA form or file.

The server computer may be programmed to generate appropriate billingfiles or forms and to transmit those billing files or forms to a payor.The server computer also may be programmed to compare the patientprofile assigned to a patient to predetermined criteria for disabilityratings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and form a part ofthe specification, illustrate the embodiments of the present inventionand, together with the description, serve to explain the principles ofthe invention.

FIG. 1 is block diagram of the Invention and the information collectedby the Invention.

FIG. 2 is a schematic diagram of the connection of the client computerto the server computer.

FIG. 3 is a schematic diagram of the collection of EMG data.

FIG. 4 is a schematic diagram of the collection of ROM data.

FIG. 5 is a schematic diagram of the collection of isometric functiondata.

FIG. 6 is a schematic diagram of the collection of grip data.

FIG. 7 is a schematic diagram of the collection of pinch data.

FIG. 8 is a block diagram of signal flow through the CNMP housing.

FIG. 9 is a block diagram of the signal conditioning and conversioncircuit board.

FIG. 10 is a block diagram of information flow through the clientcomputer and server computer.

FIG. 11 is a flowchart of the select patient function of the clientcomputer software.

FIG. 12 is a flowchart of the new patient function of the clientcomputer software.

FIG. 13 is a flowchart of the zoom patient protocol function of theclient computer software.

FIG. 14 is a flowchart of the run test function of the client computersoftware.

FIG. 15 is a flowchart of the upload data function of the clientcomputer software.

FIG. 16 is a flowchart of the download data function of the clientcomputer software.

FIG. 17 is a flowchart of the ‘about’ function of the client computersoftware.

FIG. 18 is a flowchart of the ‘quit’ function of the client computersoftware.

FIG. 19 is a flowchart of the server computer analysis.

DESCRIPTION OF THE PREFERRED EMBODIMENT

As shown by FIG. 1, the ‘Comprehensive Neuromuscular Profiler’ (“CNMP”)2 of the present invention is an integrated data acquisition device fordetecting, recording and analyzing information relating to a patient.The CNMP 2 comprises surface electromyography (“EMG”) sensors 4, rangeof motion (“ROM”) sensor 6, grip strength sensor 8, finger pinchstrength sensor 10, isometric function capacity sensor 12, and a videocamera 14, all connected to the client computer 34. The sensorsrespectively generate EMG signals 16, ROM signal 18, grip signal 20,pinch signal 22, isometric function signal 24 and video information 26.Signals generated by the sensors are conveyed to a CNMP housing 28. Inthe CNMP housing 28, the EMG signals 16, isometric function signal 24,grip signal 20 and pinch signal 22 are processed and digitized to becomeEMG data, isometric function data, grip data and pinch data, referred tocollectively in this application as “CNMP data” 30. The ROM signal 18also is processed in the CNMP housing 28 to become ROM data 32. Thevideo information 26 from the video camera 14 is passed directly to afirst client computer 34; which may be a personal computer. CNMP data 30and ROM data 32 are transmitted from the CNMP housing 28 to the firstclient computer 34, The CNMP data 30, ROM data 32 and video information26 may be transmitted to a server computer 36 over a network 38.

As illustrated by FIG. 2, the server computer 36 evaluates the CNMP data30 and ROM data 32. The server computer 36 assigns a patient profile 40to the patient based on the evaluation and transmits the patient profile40 to a second client computer 35 for display 42 to an authorized usersuch as an insurer or employer. Alternatively, some or all of the dataanalysis may be performed by the first client computer 34 and some orall of the generation of patient profile 40 may occur within the firstclient computer 34.

Generation of EMG signal 16 by the EMG sensors 4 is illustrated by FIG.3. As shown by FIG. 3, a grounding sensor and one or more differentialpairs of EMG sensors 4 are attached to predetermined locations 44, asspecified in Table 1 below, on patient 46. A total of thirty-six EMGsensors 4 (18 signal pairs) may be attached to the patient 46 usingtechniques well known in the art. An EMG sensor 4 is connected by EMGcable assembly 48 to CNMP housing 28. Two EMG cable assemblies 48 areprovided. Each EMG cable assembly 48 is conventional and comprisesnineteen individual coaxial sensor cables (9 pairs of differentialleads) plus a single ground sensor. Each EMG cable assembly 48 is ableto accommodate nine EMG signal pairs and the ground sensor 4 and iscapable of conveying these nine separate EMG signal pairs 16. Eachcoaxial cable is shielded to help eliminate any cross channel noise. TheCNMP housing 28 is capable of processing each of the eighteen channelsof EMG signals 16 generated by the EMG sensors 4 and samples the EMGsignals 6 at a rate of 15 KHz. The Invention is not limited tothirty-six EMG sensors 4 (18 pairs), and any number of EMG sensors 4 maybe utilized.

The appropriate number of EMG sensors 4 is specified for each test to beperformed on patient 46. The EMG sensors 4 are conventional silverchloride electrodes. Pairs of EMG sensors 4 are selected for eachpredetermined location 44 on the patient 46. The predetermined locations44 on the patient 46 are selected to provide EMG signals 4 relating tothe muscles in question and relating to muscles that, may becompensating for the muscles in question.

FIG. 4 illustrates generation of a range-of-motion (“ROM”) signal 18. AROM transmitter 50 creates an electromagnetic field 52 in the vicinityof patient 46. A ROM sensor 6 is attached to the body of patient 46 at aROM sensor predetermined location 56, as specified in Table 2, below.The ROM sensor 6 generates a ROM signal 18 in response to a position ofthe ROM sensor 6 within the electromagnetic field 52. The ROM sensor 6is connected by a ROM sensor cable 58 to the CNMP housing 28. A ROMsignal processor 60, as shown by FIG. 8, processes the ROM signal 18into ROM data 32.

The electromagnetic field 52 generated by the ROM transmitter 50 is aDC-based pulsed electromagnetic field. A single ROM sensor 6 is adequatefor purposes of the Invention, although any number of ROM sensors 6 maybe used. The ROM sensor 6 attached to the patient 46 contains circuitrythat relays the position of the ROM sensor 6, and hence the position ofthe patient's 46 body to which the ROM sensor 6 is attached, in theelectromagnetic field 52. The position of the ROM sensor 6 and of thepatient 46 are represented through position and angular movements in sixdegrees of freedom: x, y, z, pitch, roll, and yaw. The ROM sensor 6operates at a frequency of 100 Hz or more, although any suitablefrequency may be used.

A suitable ROM transmitter 50, ROM sensor 6 and ROM signal processingunit 60 is the Nest of Birds™ pulsed DC electromagnetic sensing productavailable from Ascension Technology Corporation, P.O. Box 527,Burlington, Vt. 05402. The Internet address of Ascension Technologies iswww.ascension-tech.com.

Other ROM sensing technologies may be suitable, such as ACelectromagnetic sensing or optical sensing. Pulsed DC electromagneticsensing offers advantages over these technologies. Optical sensingrequires that a clear line of sight be maintained, which is not requiredin magnetic sensing. AC electromagnetic sensing involves arapidly-fluctuating magnetic field, which induces eddy currents inconductive materials in the electromagnetic field. The eddy currentsintroduce interference and noise into the data and environment, greatlyincreasing electromagnetic interference issues with other equipment inthe general vicinity of the CNMP. Pulsed DC electromagnetic sensingreduces the problem of eddy currents, although stray magnetic fields andnearby metallic objects can reduce the performance of the pulsed DCsystem.

As used in this application the term “remote sensing technology” meansany technology involving the location of a detector with respect to asource of energy or in an energy field. The term “remote sensingtechnology” includes pulsed DC electromagnetic sensing, as describedabove, AC electromagnetic sensing, optical sensing, and any otherposition sensing technology that involves location of a detector withrespect to an energy source or an energy field.

FIG. 5 illustrates the generation of an isometric function signal 24from a isometric function sensor 12. The isometric function sensor 12comprises a footplate 62 and a strain gauge 64 mounted on the footplate62. A cord 66 is attached to strain gauge 64 and a handle 68 is attachedto cord 66. The patient 46 stands on the footplate 62 and pulls upwardon the handle 68, exerting a force on cord 66 and hence on strain gauge64. Strain gauge 64 generates a isometric function signal 24 in responseto force exerted by patient 46.

A suitable strain gauge 64 is an S-beam load cell, model L2350, fromFutek Advanced Sensor Technology (“Futek”), 10 Thomas, Irvine, Calif.92618. The strain gauge 64 has a rated capacity of 300 pounds of forceand can detect increments of 0.3 pounds of force. The isometric functionsignal 24 varies between −2.5 and +2.5 volts, depending on the forceexerted on the strain gauge 64.

Isometric function signal 24 is conveyed by isometric function cable 70to CNMP housing 28. The isometric function signal 24 is processed toisometric function data within the CNMP housing by a single channel,which operates at 100 Hz or more, but which may be operated at anysuitable frequency.

FIG. 6 illustrates generation of the grip strength signal 20 by the gripstrength sensor 8. The patient 46 grips the grip strength sensor 8 inhis or her hand and exerts as much gripping force as possible. Apressure transducer within the grip strength sensor 8 generates the gripstrength signal 20, which may vary between −2.5 and +2.5 volts,depending on the gripping force exerted by patient 46. The grip strengthsignal 20 is transmitted through grip sensor cable 74 to the CNMPhousing 28. The grip strength signal 20 is converted to grip data withinthe CNMP housing 28 by a single channel that operates at a frequency of100 Hz or more, but which may operate at any suitable frequency. Asuitable grip strength sensor 8 is the Jamar Grip Strength Gage model5030PT manufactured by Sammons Preston, Inc. The internet address forSammons Preston is www.sammonspreston.com.

FIG. 7 illustrates generation of the pinch strength signal 22 by thepinch strength sensor 10. The patient 46 pinches the pinch strengthsensor 10 between a thumb and a finger. The pinch strength sensor 10generates a pinch strength signal 22 in response to the force applied bythe patient 46 to the pinch strength sensor 10. A suitable pinch sensor10 is model L1020-Q10510 from Futek. The pinch strength signal 22 variesbetween −2.5 to +2.5 volts, depending on the force exerted on the pinchstrength sensor 10 by the patient 46. The pinch strength signal 22 istransmitted through the pinch strength sensor cable 72 to the CNMPhousing 28. The pinch strength signal 22 is processed within the CNMPhousing 28 by a single channel that operates at a frequency of 100 Hz ormore, but which may operate at any suitable frequency.

As shown by FIGS. 3 through 7, video camera 14 records video images ofthe patient 46 while any or all of EMG sensors 4, ROM sensor 6, gripstrength sensor 8, pinch strength sensor 10 or isometric function sensor12 are in use. The video camera 14 generates video information 26 thatis transmitted through video cable 76 to the first client computer 34.The video information 26 is passed into a PCMCIA card acting as a USBhub and is stored for future reference. The video information 26 may bemonitored by a healthcare provider during the tests and may be stored asa visual record of the tests.

FIG. 8 illustrates the operations occurring in the CNMP housing 28. ROMsignal 18 enters CNMP housing 28 by way of a suitable input jack and isconveyed to ROM signal processing device 60. ROM signal processingdevice 60 converts ROM signal 18 to ROM data 32, ready for furtherprocessing by first client computer 34. As indicated above, a suitableROM signal processing device 60 is the Nest of Birds™ product byAscension Technologies Corporation. ROM data 32 is conveyed to asuitable output jack.

Isometric function signal 24, grip signal 20 and pinch signal 22, eachappearing as a single channel, enter the CNMP housing 28 throughsuitable input jacks and are processed by signal conditioning andconversion board 78. Two EMG cable assemblies 48 are connected to theCNMP housing 28 by suitable jack connections, each of the EMG cableassemblies 48 is able to convey nine channels of EMG signal 16 fromeighteen separate EMG sensors 4. Each channel of EMG signal 16 isprocessed by the signal conditioning and conversion board 78. The outputof the signal conditioning and conversion board 78 is CNMP data 30comprising EMG data 82, isometric function data 84, grip data 86 andpinch data 88, all ready for further processing by client computer 34.CNMP data 30 is output at a suitable output jack.

FIG. 9 illustrates operation of the signal conditioning and conversionboard 78. The signal conditioning and conversion board 78 conditions EMGsignal 16, isometric function signal 24, pinch signal 22, and gripsignal 20 and converts those signals 16, 24, 22, 20 to digital form tobe used by the client computer 34 for further processing and analysis.

A shown by FIG. 9, The EMG section of the signal conditioning andconversion board 78 begins with the EMG cable assemblies 48 being fedinto an input protection device 90 in order to isolate any high voltagethat is potentially dangerous. The resulting signals are sent through anamplification and filtering module 92. The EMG signals 16 are convertingto a corresponding voltage, based on the resistance between the EMGsensor 4 pairs. The filtering module 92 provides 60 Hz filtering, with acommon mode rejection ratio of 90 dB at a range of 0-100 Hz. Theresulting signals are fed through analog multiplexers 94, in order toaccount for the numerous channels of the surface EMG signal 16. Themultiplexers 94 are controlled by a master timing and control mechanism96, which allows a consistent pass-through of signals through themultiplexer 94 array.

Once the processed EMG signals 16 are passed through the multiplexers94, the signals 16 are sent through an analog-to-digital convertercircuit 98, which changes the EMG signals 16 signals to a digital EMGdata 82 in order to prepare the EMG signals 16 for further processing inclient computer 34.

The grip, pinch, and functional capacity section of the signalconditioning and conversion board 60 begins with the grip strengthsensor cable 74, pinch strength sensor cable 72 and isometric functionsensor cable 70 feeding the grip signal 20, pinch signal 22 or isometricfunction signal 24 into an amplification and bridge gain circuit 100.The differential grip signal 20, pinch signal 22 or isometric functionsignal 24 is converted into a corresponding voltage. The bridge gaincircuit 100 also provides a DC amplification voltage along with anisolated ground component to provide sensor bridge amplification. Theresulting processed grip signal 20, pinch signal 22 or isometricfunction signal 24 is fed through analog multiplexers 102, 94, in orderto account for the numerous channels of EMG signal 16. The multiplexers102, 94 are controlled by a master timing and control mechanism 96,which allows a consistent pass-through of signals through themultiplexer 102, 94 array.

Once the processed grip signal 20, pinch signal 22 or isometric functionsignal 24 is passed through the multiplexer array 102, 94, the signal issent through an analog-to-digital converter circuit 98, which changesthe grip signal 20, pinch signal 22 or isometric function signal 24 to adigital grip data 86, pinch data 88 or isometric function data 84 inorder to prepare the grip signal 20, pinch signal 22 or isometricfunction signal 24 for further processing by first client computer 34.

The system voltages component 104 of the signal conditioning andconversion board 60 is a stand-alone power supply. The system voltagescomponent 104 operates at a constant voltage of 5 volts at a current of2 amps. The system voltages component 104 also contains a differentialvoltage of −12 to +12 volts at an approximate current of 0.4 amps. Theresulting signals from the power supply are fed into a multiplexer 106for distribution in the circuit.

All of the resulting digital EMG data 82, grip data 86, pinch data 88and isometric function data 84 from the analog-to-digital converters 98are passed on to a parallel-to-serial converter 108, which prepares theoutput of the converters 108 to be sent over a standard USB interface tothe first client computer 34. The resulting EMG data 82, grip data 86,pinch data 88 and isometric function data 84 are subject to a digitalisolation circuit 110, in order to isolate the patient 46 and otherparticipants from the signal conditioning and conversion board 78. TheEMG data 82, grip data 86, pinch data 88 and isometric function data 84are sent from the signal conditioning and conversion board 78 over a USBinterface into a USB port on the first client computer 34.

FIG. 10 illustrates the flow of information from the CNMP housing 28.From the CNMP housing 28, ROM data 32 and CNMP data 30 are fed to firstclient computer 34. CNMP data 30 comprises EMG data 82, grip data 86,pinch data 88 and isometric function data 84. Video information 26 alsois fed to the first client computer 34. First client computer 34 memory112 contains first client computer software 114 that controls operationof first client computer microprocessor 116. In response to appropriatecommands from a user, first client computer microprocessor 116 directsstorage of ROM data 32, video information 26 and CNMP data 30 in firstclient computer memory 112. Instructions and other information aredisplayed to user by display 42.

On instruction from user, first client computer microprocessor 116 mayconnect to computer network 38 and negotiate a network connection withserver computer 36. First client computer microprocessor 116 may directthat ROM data 32, video information 26 and CNMP data 30 be sent toserver computer 36 over computer network 38 in an encrypted format toprotect patient information.

Server computer 36 includes server computer microprocessor 118 andserver computer memory 120. Server computer memory 120 contains anexpert database 122. Server computer microprocessor 118 is programmed toanalyze ROM data 32 and CNMP data 30 and to extract patterns from thesedata. Server computer microprocessor 118 compares the patterns detectedto expert database 122 and associates a patient profile 40 with thedetected patterns. Server computer 36 may transmit the patient profile40 to the first client computer 34 over network 38 for display 42 touser. Alternatively, server computer 36 may transmit patient profile 40over computer network 38 to the second client computer 35 for display toany authorized person, such as an insurer or employer.

FIGS. 11-17 describe the operation of first client computer software114. The software 114 is resident in the first client computer memory112 and operates the comprehensive neuromuscular profiler system. Inoverview, the first client computer software 114 allows a user to selector to enter information about a patient 46 into the first clientcomputer memory 112. The first client computer software 114 allows theuser to select among several different protocols for tests to beadministered to a patient 46. Each protocol is designed to collectinformation about the functioning of a particular portion of thepatient's 46 body. The first client computer software 114 allows firstclient computer 34 to display to the user or to the patient 46information about a selected protocol, including which of the EMGsensors 4, ROM sensor 6, isometric function sensor 12, grip strengthsensor 8 or pinch strength sensor 10 should be used during each portionof the protocol. The first client computer software 114 may instruct theuser as to the correct location and placement of the EMG sensors 4 andROM sensor 6. The first client computer software 114 may instruct thepatient as to the correct performance of each task in the selectedprotocol.

The first client computer software 114 oversees collection of theappropriate EMG data 82, ROM data 32, grip data 86, pinch data 88 andisometric function data 84 and also oversees recording of videoinformation 26. The first client computer software 114 allows firstclient computer 34 to transmit CNMP data 30, ROM data 32 and videoinformation 30 to a server computer 36 over computer network 38. Thefirst client computer software may allow first client computer toreceive the patient profile 40 from the server computer 36 aftercompletion of the analysis by the server computer 36.

Each of the above steps relating to the first client computer software114 is described in more detail in the following paragraphs.

A first client computer 34 running the client computer software 114displays a ‘main’ screen 124 to a user. The user is a technician whoadministers the test protocols to the patient 46. The user is presentedwith several options on the Main screen 124, and the user may select anyof the options using any of the techniques that are well known in theart.

As shown by FIG. 11, from the Main screen 124 the user may select the“open patient” option 126. The user is presented with a select patientscreen 128 that allows the user to select the identity of the patient 46(either by name or by some other unique identifier) from a list ofpatient 46 identities. Patient 46 information includes identifyinginformation for the patient 46 and such other information as is deemednecessary, which may include insurance information, diagnosisinformation, prior test results, and any other information that may bedesirable. Patient 46 information is stored in encrypted form on thefirst client computer memory 112. The user selects 130 one of the uniquepatient identifiers and the patient 46 information for that patient 46is decrypted and displayed 132 to the user in one or more screens. Theuser then may edit or add to the patient information 134, includingperforming additional protocols as described below. After the entry ofnew patient information is completed, the user may elect to save 136 thenew patient information, in which case the patient information isencrypted and saved 138 to the hard disk. Alternately, the user mayelect to cancel 140 the entry of patient information at any time andreturn to the Main menu. The user also may clear patient information 142entered without returning to the main menu. The user may elect to cancelopening of a patient file 144, in which case existing patient files arenot amended.

As shown by FIG. 12, the user may enter information concerning a newpatient for whom no file is saved within the, computer system. From theMain menu 124, the user selects “new patient” 144. The user is presentedwith patient information screens with the fields blank 146. The userthen enters information into the blank fields, as appropriate 148. Theinformation entered may include new protocol data derived from theadministration of a protocol to the patient, as discussed below. Oncethe entry of the new patient information 148 is complete, the user mayelect to save the information 150. The information is then encrypted andsaved to the hard disk drive 152 of the first client computer 34. Theuser also may elect to clear the new patient information 154 or tocancel the operation 156 and return to the main screen.

FIG. 13 shows the “Zoom patient protocol” option presented to the userby the Main menu 124. As used in this application, the term “zoom” meansto selectably enlarge an image on the display screen. For the “zoompatient protocol,” the user is presented with an image of a region onthe human body. The user selects 158 the region of the human bodycorresponding to the protocol to be administered to the patient. Theimage of the body region selected “zooms” 160; that is, enlarges, on thedisplay monitor 42. The proper location of the EMG sensor 4 locationsfor the selected patient protocol are illustrated on the enlarged imageof the body and a list of the muscles to be monitored is displayed tothe user.

Eight different protocols are available to the user, and hence eightdifferent locations may be “zoomed” 160. Those protocols are as follows:Cervical, Thoracic, Lumbosacral, Carpal Tunnel, Shoulder, LowerExtremities, Custom Ankle, and Hip & Groin. Each of the protocolsprovide EMG sensor 4 locations for the left and the right sides of thepatient's 46 body, resulting in a total of sixteen different sets of EMGsensor locations 44. The appropriate EMG sensor locations 44 for theeight protocols are contained in Table 1.

TABLE 1 ELECTRODE PLACEMENTS

The EMG sensors 4 are attached to the patient in a conventional mannerfor use of EMG technology. Conventional connection requires that apatient 46 ground be established with one EMG sensor 4 as a referenceand that two EMG sensors 4 be attached to each muscle to be evaluated.The data collected by the two EMG sensors 4 represents a difference inelectrical potential between the two EMG sensors 4 connected to eachmuscle.

Each protocol also involves the use of a remote tracking device (ROMsensor 6). The ROM sensor 6 is attached to the body of the patient 46 atthe location specified by Table 2. The ROM sensor 6 is attached by anelastic bandage, by a strap, by incorporating the ROM sensor 6 into anarticle of clothing, by an adhesive or by any other suitable means.

TABLE 2 Protocol Motion detector location Cervical Protocol Back of thehead Thoracic Protocol Vicinity of T4-T5 vertebrae Lumbosacral ProtocolTop of the Head Carpal Tunnel Protocol Hand or Wrist Shoulder ProtocolBack of the head Lower Extremities Knee Cap Protocol Custom AnkleProtocol Ankle or Foot Hip & Groin Protocol Top of the QuadricepsFemoris

The “zoom patient protocol” screens of FIG. 13 are useful for usertraining and as a check to the user concerning EMG sensor 4 placement.It is anticipated that as a user becomes facile with the operation ofthe apparatus that the user will not require instruction by the “zoompatient protocol” 158, 160.

FIG. 14 illustrates the use of the first client computer software 114 toperform a protocol and record the results of the protocol. From the Mainmenu 124, the user elects to run a protocol 162 and selects the protocolthat will be run. The cervical protocol is the default if no otherprotocol is selected. The user is unable to select the “run test” 162command unless a new or existing patient file 136, 150 has been loaded.The user may elect to “zoom patient protocol” 164, as described above,to see an illustration of proper EMG sensor 4 placement and a list ofmuscles to be monitored.

The user will then administer the protocol 166 to the patient. Eachprotocol comprises several steps. Each protocol includes tests requiringthat the patient 46 be connected to a plurality of EMG sensors 4 and toan ROM sensor 6 that are in turn connected to the CNMP housing 28through EMG sensor cables 48 and a ROM sensor cable 58. Some of theprotocols also involve the patient 46 exerting force against anisometric function sensor 12, a grip strength sensor 8, or a fingerpinch sensor 10, each of which is connected to the CNMP housing 28. Thepatient 46 follows instructions by the user or as instructed by thesoftware as the patient 46 performs several tasks. The instructions aredisplayed to the user and the user verbally instructs the patient 46 toperform the task. Alternatively, the instructions may be displayed tothe user on, for example, a computer monitor 42. The tasks are designedto challenge specific muscles to allow measurement of the electricalcharacteristics of the muscles as they are challenged. Each of the tasksare timed and the patient 46 is allowed fifteen seconds to complete eachtask.

The first client computer 34 records data as the tests are administered168. EMG data 82 of the monitored muscles is recorded continuously. TheROM data 32 is collected during the time that the patient 46 isperforming a task relating to motion of a body part of the patient 46.The patient 46 is recorded by video camera 14 to create a video recordof patient 46 compliance and to allow monitoring by a health careprofessional. The user also monitors patient 46 compliance and properperformance of the test by the patient 46.

The sequential instructions and challenges to the patient 46 for eachstep of each protocol is provided below. The protocol instructions belowalso include instructions to the user to connect or disconnect theisometric function sensor 12 (also referred to as the ‘IFT’), the gripsensor 8 and the finger pinch sensor 10, as appropriate for theparticular protocol being administered. The ROM sensor 6 is referred toas the “motion tracking device” in the descriptions below. The patient46 is provided a rest period of fifteen seconds between each of theprotocol steps listed below.

Cervical Protocol

-   a. (flexion/extension) “Slowly bend your head at a constant speed in    an arc such that you bend forward to look at the floor and then    sweep it backwards such that you are looking at the ceiling. Repeat    three times, pausing for two seconds between each repetition.”-   b. (rotation) “Slowly turn your head at a constant speed to the    right, back to center and then to the left. Repeat three times,    pausing for two seconds between each repetition.”-   c. (lateral bending) “Slowly and at a constant speed with your gaze    fixed on the wall straight ahead at eye level, try to bring your    right ear to your right shoulder, then sweep back through the center    to try to bring your left ear to your left shoulder without moving    anything but your head. Repeat three times, pausing for two seconds    between each repetition.”    Thoracic Protocol-   a. (Flexion/extension) “Slowly bend forward at the waist at a    constant speed while keeping your legs straight, then return to    center and then bend backwards and return to center. Repeat three    times, pausing for two seconds between each repetition.”-   b. (Rotation) “Bend over at the waist such that your upper body and    lower body are at a 90 degree angle and cross your arms over your    chest. Slowly and at a constant speed, twist your upper body to the    right, return to center, then twist to the left and return to    center. Repeat three times, pausing for two seconds between each    repetition”-   c. (Lateral Bending) “Stand upright at rest with your gaze fixed on    the wall straight ahead at eye level with your arms hanging straight    down at your sides. Slowly and at a constant speed, lean to your    right and slide your right hand down your right leg, return to rest    and then lean to your left and slide your left hand down your left    leg and return to rest. Repeat three times, pausing for two seconds    between each repetition.”-   d. (Rowing) “Stand upright with your arms straight out from your    body at shoulder level while looking straight forward with your gaze    fixed on a spot on the wall at eye level. Slowly and at a constant    speed, pull each hand to its respected shoulder by bending your    elbows, then return to full extension. Repeat three times, pausing    for two seconds between each repetition.”-   e. (Abduction/Adduction) “Stand upright with your arms relaxed at    your sides while looking straight forward with your gaze fixed on a    spot on the wall at eye level. Slowly and at a constant speed while    keeping your elbows locked, lift your arms sideways from your body    over your head and then bring them down again to your sides. Repeat    three times pausing, for two seconds between each repetition.”-   f. (Upright Rowing) “Stand upright with your arms relaxed at your    sides while looking straight forward with your gaze fixed on a spot    on the wall at eye level. Slowly and at a constant speed, simulate    pulling a bar up with both hands to your chin by bending your    elbows. Repeat three times, pausing for two seconds between each    repetition.”    Lumbosacral Protocol-   a. (Flexion/Extension) “Slowly bend forward at the waist at a    constant speed while keeping your legs straight, then return to    center and then bend backwards and return to center. Repeat three    times, pausing for two seconds between each repetition.”-   b. (Rotation) “Stand upright with your arms relaxed at your sides    while looking straight forward with your gaze fixed on a spot on the    wall at eye level. Slowly and at a constant speed, twist your upper    body to the right, back to center, to the left and return to center.    Repeat three times, pausing for two seconds between each    repetition.”-   c. (Lateral Bending) “Stand upright at rest with your gaze fixed on    the wall staight ahead at eye level with your arms hanging straight    down at your sides. Slowly and at a constant speed, lean to your    right and slide your right hand down your right leg, return to rest    and then lean to your left and slide your left hand down your left    leg and return to rest. Repeat three times, pausing for two seconds    between each repetition.”-   d. (IFT Underhand Lifting) “Place your feet on either side of the    [IFT] bar at shoulder width while gripping the handle UNDERHANDED    with the handle held a few inches above your knees. While keeping    your arms straight and knees bent, straighten your legs to lift up    on the bar as hard as you can and then return to rest. Repeat three    times, pausing for two seconds between each repetition.”-   e. (IFT Overhand Lifting) “Place your feet on either side of the bar    at shoulder width while gripping the handle OVERHANDED with the    handle held a few inches above your knees. While keeping your arms    straight and knees bent, straighten your legs to lift up on the bar    as hard as you can and then return to rest. Repeat three times,    pausing for two seconds between each repetition.”    Carpal Tunnel Protocol-   a. (Flexion/Extension) “Slowly bend your head at a constant speed in    an arc such that you bend forward to look at the floor and then    sweep it backwards such that you are looking at the ceiling. Repeat    three times.”-   b. (Rotation) “Slowly turn your head at a constant speed to the    right, back to center and then to the left. Repeat three times,    pausing for two seconds between each repetition.”-   c. (Lateral Bending) “Slowly and at a constant speed with your gaze    fixed on the wall straight ahead at eye level, try to bring your    right ear to your right shoulder, then sweep back through the center    to try to bring your left ear to your left shoulder without moving    anything but your head. Repeat three times, pausing for two seconds    between each repetition.”

Rest Standing “Stand upright with your arms relaxed at your sides whilelooking straight forward with your gaze fixed on a spot on the wall ateye level.”

-   d. (System Check) “Ensure the Motion Tracking Device is installed on    the back of the patient's RIGHT hand.”-   e. (Wrist Extension RIGHT) “Bring your RIGHT arm straight out in    front of your body at shoulder level and slowly and at a constant    speed bend the wrist up and then return it to rest. Repeat three    times, pausing for two seconds between each repetition.”-   f. (Wrist Flexion/Finger Grasp RIGHT) “Bring your RIGHT arm straight    out in front of your body at shoulder level with your fingers spread    and bend your wrist down and then close your fingers and make a    fist, then relax your fingers and return your wrist to rest. Repeat    three times, pausing for two seconds between each repetition.”-   g. (System check) “Ensure the Motion Tracking Device is installed on    the back of the patient's LEFT hand.”-   h. (Wrist Extension LEFT) “Bring your LEFT arm straight out in front    of your body at shoulder level and slowly and at a constant speed    bend the wrist up and then return it to rest. Repeat three times,    pausing for two seconds between each repetition.”-   i. (Wrist Flexion/Finger Grasp LEFT) “Bring your LEFT arm straight    out in front of your body at shoulder level with your fingers spread    and bend your wrist down and then close your fingers and make a    fist, then relax your fingers and return your wrist to rest. Repeat    three times, pausing for two seconds between each repetition.”-   j. (IFT Installation) “Place the IFT plate on the floor and adjust    the strap length as dictated by the protocol.”-   k. (IFT Underhand Lifting) “Place your feet on either side of the    bar at shoulder width while gripping the handle UNDERHANDED with the    handle held a few inches above your knees. While keeping your arms    straight and knees bent, straighten your legs to lift up on the bar    as hard as you can and then return to rest. Repeat three times,    pausing for two seconds between each repetition.”-   l. (IFT Overhand Lifting) “Place your feet on either side of the bar    at shoulder width while gripping the handle OVERHANDED with the    handle held a few inches above your knees. While keeping your arms    straight and knees bent, straighten your legs to lift up on the bar    as hard as you can and then return to rest. Repeat three times,    pausing for two seconds between each repetition.”-   m. (Jamar grip installation) “Give the patient the Jamar Grip Device    to hold in their right hand.”-   n. (Grip RIGHT) “Hold the Jamar Grip Device in your RIGHT hand with    your arm at your side and lift it with a slightly bent elbow to    waist level with your wrist held staight and grip/squeeze the Jamar    as hard as you can, then release and return your arm to your side.    Repeat three times, pausing for two seconds between each    repetition.”-   o. (Grip LEFT) “Hold the Jamar Grip Device in your LEFT hand with    your arm at your side and lift it with a slightly bent elbow to    waist level with your wrist held staight and grip/squeeze the Jamar    as hard as you can, then release and return your arm to your side.    Repeat three times, pausing for two seconds between each    repetition.”-   p. (Pinch Device Installation) “Take the Jamar Grip Device from the    patient and give them the Pinch Sensor Device to hold in their right    hand.”-   q. (Pinch RIGHT) “Hold the pinch sensor in your RIGHT hand between    your thumb and index finger with your arm at your side and squeeze    the sensor as hard as you can. Repeat three times, pausing for two    seconds between each repetition.”-   r. (Pinch LEFT) “Hold the pinch sensor in your LEFT hand between    your thumb and index finger with your arm at your side and squeeze    the sensor as hard as you can. Repeat three times, pausing for two    seconds between each repetition.”    Shoulder-   a. (Flexion/Extension) “Slowly bend your head at a constant speed in    an arc such that you bend forward to look at the floor and then    sweep it backwards such that you are looking at the ceiling. Repeat    three times, pausing for two seconds between each repetition.”-   b. (Rotation) “Slowly turn your head at a constant speed to the    right, back to center and then to the left. Repeat three times,    pausing for two seconds between each repetition.”-   c. (Lateral Bending) “Slowly and at a constant speed with your gaze    fixed on the wall straight ahead at eye level, try to bring your    right ear to your right shoulder, then sweep back through the center    to try to bring your left ear to your left shoulder without moving    anything but your head. Repeat three times, pausing for two seconds    between each repetition.”-   d. (Shoulder Shrug) “Standing in an upright position with your arms    at your sides, elevate your shoulders towards your ears and hold for    approximately two seconds and then return to rest. Repeat three    times.”-   e. (Abduction/Adduction) “Stand upright with your arms relaxed at    your sides while looking straight forward with your gaze fixed on a    spot on the wall at eye level. Slowly and at a constant speed while    keeping your elbows locked, lift your arms sideways from your body    over your head and then bring them down again to your sides. Repeat    three times pausing, for two seconds between each repetition.”-   f. (Interior/Exterior Rotation) “While standing upright with your    arms at your side with the elbows locked at 90 degrees; slowly and    at a constant speed bring your hands up towards and past your ears    and then bring them back down and to the back as far as possible    then return to rest. Repeat three times, pausing for two seconds    between each repetition.”-   g. (IFT Installation) “Place the IFT plate on the floor and adjust    the strap length as dictated by the protocol.”-   h. (IFT Underhand Lifting) “Place your feet on either side of the    bar at shoulder width while gripping the handle UNDERHANDED with the    handle held a few inches above your knees. While keeping your arms    straight and knees bent, straighten your legs to lift up on the bar    as hard as you can and then return to rest. Repeat three times,    pausing for two seconds between each repetition.”-   i. (IFT Overhand Lifting) “Place your feet on either side of the bar    at shoulder width while gripping the handle OVERHANDED with the    handle held a few inches above your knees. While keeping your arms    straight and knees bent, straighten your legs to lift up on the bar    as hard as you can and then return to rest. Repeat three times,    pausing for two seconds between each repetition.”    Lower Extremities Protocol-   a. (Walking) “Take 3 steps forward and then 3 steps backwards to    return to the original position. Repeat three times, pausing for two    seconds between each repetition.”-   b. (Walking) “Take 3 steps forward and then 3 steps backwards to    return to the original position. Repeat three times, pausing for two    seconds between each repetition.”-   c. (Knee Flexion/Extension RIGHT) “While supporting yourself on a    stationary object, raise your RIGHT leg straight forward in front of    your body and then bend the knee, straighten your leg again and then    return to a standing position. Repeat three times, pausing for two    seconds between each repetition.”-   d. (Knee Flexion/Extension LEFT) “While supporting yourself on a    stationary object, raise your LEFT leg straight forward in front of    your body and then bend the knee, straighten your leg again and then    return to a standing position. Repeat three times, pausing for two    seconds between each repetition.”-   e. (Deep Knee Bends) “While supporting yourself on a stationary    object, perform a deep knee bend while ensuring that your legs never    exceed a maximum angle of 90 degrees to one another. Repeat three    times, pausing for two seconds between each repetition.”Custom Ankle    Protocol-   a. (Walking) “Take 3 steps forward and then 3 steps backwards to    return to the original position. Repeat three times, pausing for two    seconds between each repetition.”-   b. (Walking) “Take 3 steps forward and then 3 steps backwards to    return to the original position. Repeat three times, pausing for two    seconds between each repetition.”-   c. (Ankle Flexion/Extension RIGHT) “While supporting yourself on a    stationary object while keeping your LEFT leg straight, lift your    RIGHT leg by bending at the knee and bend your ankle slowly and at a    constant speed such that your toes point down, center and then up    and back to center. Repeat three times, pausing for two seconds    between each repetition.”-   d. (Ankle Rotation RIGHT) “While supporting yourself on a stationary    object while keeping your LEFT leg straight, lift your RIGHT leg by    bending at the knee and rotate your ankle slowly and at a constant    speed to the right, back to center, back to left and finally    returning to center. Repeat three times, pausing for two seconds    between each repetition.”-   e. (Ankle Flexion/Extension LEFT) “While supporting yourself on a    stationary object while keeping your RIGHT leg straight, lift your    LEFT leg by bending at the knee and bend your ankle slowly and at a    constant speed such that your toes point down, center and then up    and back to center. Repeat three times, pausing for two seconds    between each repetition.”-   f. (Ankle Rotation LEFT) “While supporting yourself on a stationary    object while keeping your RIGHT leg straight, lift your LEFT leg by    bending at the knee and rotate your ankle slowly and at a constant    speed to the right, back to center, back to left and finally    returning to center. Repeat three times, pausing for two seconds    between each repetition.”    Hip & Groin Protocol-   a. (Flexion/Extension RIGHT) “While supporting yourself on a    stationary object while keeping your RIGHT leg straight with the    toes pointed upwards, slowly and at a constant speed raise your leg    forward as high as possible, back to rest and then backwards as high    as possible and then return to rest. Repeat three times, pausing for    two seconds between each repetition.”-   b. (Abduction/Adduction RIGHT) “While supporting yourself on a    stationary object and keeping your RIGHT leg straight with the toes    pointed upwards swing your leg inwards to the left as far as    possible, back to center and then as far right as possible and    return to rest. Repeat three times, pausing for two seconds between    each repetition.”-   c. (Flexion/Extension LEFT) “While supporting yourself on a    stationary object while keeping your LEFT leg straight with the toes    pointed upwards, slowly and at a constant speed raise your leg    forward as high as possible, back to rest and then backwards as high    as possible and then return to rest. Repeat three times, pausing for    two seconds between each repetition.”-   d. (Abduction/Adduction LEFT) “While supporting yourself on a    stationary object and keeping your LEFT leg straight with the toes    pointed upwards swing your leg inwards to the right as far as    possible, back to center and then as far left as possible and return    to rest. Repeat three times, pausing for two seconds between each    repetition.”-   e. (Deep Knee Bends) “While supporting yourself on a stationary    object, perform a deep knee bend while ensuring that your legs never    exceed a maximum angle of 90 degrees to one another. Repeat three    times, pausing for two seconds between each repetition.”

Upon completion of each step of the selected protocol, the user mayreview graphs of the data collected to determine that the CNMP apparatus2 and the patient performed the step properly and that the data wasproperly recorded. In the ‘review step data,’ screen 170, the user ispresented with small images of data graphs for the ROM data 32 and theEMG data 82 collected. The user may “zoom” (enlarge) 172, 174 the datagraphs to verify the proper conduct of the step. On the ‘review stepdata’ screen 170, the user also is presented with a small image of thecollected video information 26, which can also be zoomed for closerexamination. If the user is satisfied that the data was properlycollected and the test properly run, the user may accept and save thedata 176. If the user detects an error in the data, for example afailure of an EMG sensor 4 or failure of the patient 46 to comply fullywith the instructions, the user may reject 178 the data and request thatthe patient 46 repeat the step. The user may ‘zoom’ a demonstrationvideo file 180 for display to the patient 46 to show the patient 46 theactions that the patient 46 will perform in the step.

The user may abort the protocol 182, deleting all collected data. Theuser also may save the protocol 184, which ‘zips’ (compresses) the CNMPdata 30 and ROM data 32 to create a smaller data file for transmissionover a network 38 to a server computer 36.

FIG. 15 illustrates the upload process for transferring the CNMP data30, ROM data 30 and video information 26 to a server computer 36 foranalysis. From the ‘Main’ screen 124, patient data is uploaded 186. Theuser logs onto the network 188, assuring the server computer 36 thatuser is authorized to access server computer 36. The user instructs theclient computer 34 to upload the data to the server computer 36 and thedata is transferred 190. The user may instruct the client computer 34 toabort 192 the upload process and is provided an opportunity to ok 196 orcancel 194 the abort command. If the upload is aborted 196, the user isreturned to the main screen 124.

FIG. 16. illustrates the download by the first client computer 34 of theresults of the data analysis by the server computer 36. The results ofthe data analysis also may be downloaded by an authorized person using asecond client computer 35. An authorized person, such as a healthcareprovider or insurance company, selects ‘download reports’198 from the‘main’ menu 124. The user logs onto the network 200, assuring the servercomputer 36 that the person is authorized to receive the requestedreport. The person instructs the server computer 36 as to the patientinformation that the person desires to receive. The server computer 36then transmits the requested information to the first or second clientcomputer 34/35, over the network 38 for display to the authorizedperson. The first or second client computer 34/35, follows the progressof the download 202. The download may be aborted 204 and the abort maybe cancelled 206.

From FIGS. 17 and 18, the ‘main’ menu 124 also allows the user to accessan ‘about’ screen 208 providing information about the software. The mainmenu also allows the user to ‘quit’ 210 the program.

The first client computer software 114 provides methods for failuredetection and override. If any sensor 4, 6, 8, 10, 12 or cable 48, 58,70, 72, 74, 76 is detected to be faulty, the first client computersoftware 114 alerts the user, and allows the user to override thedetection, or halt the test to allow for fault correction. The firstclient computer software 114 also employs data encryption, to ensure theintegrity of the CNMP data 30 or ROM data 32.

FIG. 19 illustrates the operation of the server computer 36 evaluatingthe CNMP data 30 and ROM data 32. In step 212 of FIG. 18, servercomputer 36 receives ROM data 32. The ROM data 32 comprises informationrelating to range of motion of a body part of the patient 46 and thedynamic motion of the patient 46 within that range. The server computeralso receives CNMP data 30 comprising pinch data 88, grip data 86,isometric function data 84 and EMG data 82. The server computermicroprocessor 118 is programmed to perform pre-determined dataevaluation on the data received. As indicated on step 214 of FIG. 19,the data evaluation comprises pattern recognition evaluation usingtechniques as known in the art, either alone or in combination. Theevaluation of the data may reveal patterns in the CNMP data 30 and ROMdata 32. As indicated on step 216 of FIG. 18, the server microprocessor118 consults an expert database 122 of patterns and combinations ofpatterns resident in server computer memory 120. The expert database 122associates one or more diagnoses, or patient profiles 40, with each ofthe patterns or combinations of patterns. From step 218, the expertdatabase 122 informs the server microprocessor 118 of the patientprofile 40 identified by the patterns and combination of patterns. Fromstep 220, the server microprocessor 118 supplies a report of the patientprofile 40 to the user or other authorized person over the computernetwork 38.

Evaluation and analysis of the data collected by the first clientcomputer 34 may be performed in whole or in part by a human expert.During collection of data for creation of the expert database, an expertphysician will review all results of the analysis and the expertdatabase will be amended to incorporate the results of the physician'sreview. Once the system has a large track record, only abnormal patternsdetected during the analysis will be referred for expert physicianreview.

The Invention is designed to provide medical professionals and otherinterested parties with an accurate method of simultaneously observingmuscular functionality and additional muscular and nervous systemcharacteristics. This will provide the users a pinpoint procedure toidentify and properly diagnose myofascial and other injuries. TheInvention achieves its goals through combining surface EMG and pulsed DCelectromagnetic range-of-motion technology, along with isometricfunctional capacity and grip/pinch strength sensors, to obtain acomprehensive set of necessary functional output signals. The Inventionuses a custom signal conditioning and conversion circuit board 78 tocondition and digitize the signals, which are then fed to a first clientcomputer 34.

The Invention is non-invasive, non-loading and portable. The Inventionuses a combination of surface EMG sensors 4, a ROM sensor 6, anisometric function sensor 12, a grip sensor 8 and a pinch sensor 10 inorder to determine the functional capability and characteristics ofmuscle group and surrounding tissues. The EMG sensors 4 obtain readingsrelated to the pathophysiological processes within a muscle, pressureexerted by blood vessels on the muscle and surrounding tissue, as wellas observing muscle characteristics such as muscle tone and presence ofspasms. The isometric function sensor 12, along with pinch 10 and grip 8strength sensors allow a higher level of accuracy in identifying certaintypes of injuries. The isometric function sensor allows the Invention tomonitor the patients' potential lifting force. This is a major factor inidentifying lower back injuries and in monitoring compliance by thepatient 46 with the performance of the test. A person who is feigninginjury may be detected through the isometric function data 84 alone orin combination with EMG data 82. The pinch and grip strength sensors 10,8 accomplish the same task as the isometric function sensor 12, exceptthat the pinch and grip sensors 10, 8 observe the functionalcharacteristics of those body parts which typically correspond to carpeltunnel syndrome and other related injuries. As used in this application,the term “functional capacity data” means data relating to the abilityof the patient to exert force using the muscles of the patient andincludes isometric function data 84, pinch data 88 and grip data 86.

The Invention uses the combination of different technologies in order tosimultaneously monitor muscle groups in order to thoroughly obtaininformation about muscle functionality, rate of fatigue, muscleresponse, and other associated muscular characteristics. Thesimultaneous use of complementary technologies allows the user toaccurately monitor the muscular compensation patterns typically seen ininjured muscle groups and their surrounding areas. These compensationpatterns are usually a key element in identifying the age and type ofinjury present.

The accuracy of the Invention allows medical professionals to have amuch higher degree of certainty when diagnosing injuries. This allowsthe patient 46 and medical professional to prescribe a more detailedcourse of action for treatment and rehabilitation, saving time andmoney. It also allows a higher level of objectivity when diagnosingwork-related injuries, saving businesses time and money that would belost through workers' compensation and ADA-related lawsuits.

The Invention allows for a high level of portability and patient 46comfort. The pulsed DC electromagnetic ROM sensor 6, transmitter 50 andROM device signal processing unit 60 provide a more accurate method ofobtaining range-of-motion data than previously available, whileproviding a very compact device which increases the ease oftransportation. The use of the electromagnetic device also does notrequire the use of harnesses or belts to attach the device to thepatient. Instead, the device is attached by a single small sensor, in amanner similar to the EMG sensors 4 used by the surface EMG component.This provides the patient 46 with a much more comfortable testingexperience, and makes the entire system less cumbersome to use thanprior art testing systems.

Use of the Invention is not limited to human injuries and may accuratelymonitor muscle groups for injury diagnosis in animals, primarily horses.

The Invention may be used to measure actual muscular potentialindependent of patient effort. The ROM data 32 and surface EMG data 82in combination allows the Invention to objectively measure the actualrange-of-motion or lifting potential of the patient 46, reducing thelikelihood of false discrimination cases and workers' compensationclaims.

The Invention also may differentiate between related injuries. Thisincludes related injuries such as paraspinal and herniated discs,vasoconstriction, and carpal tunnel syndrome and cubital tunnelsyndrome. The use of simultaneous monitoring allows for the observationof compensation patterns and additional inter-muscle relations, whichassists in the differentiation process. The Invention may assist inpre-employment screening, in order to provide pre and post-injurycomparison. The apparatus also may monitor injury healing during therehabilitation process. The apparatus may be used in the athleticcommunity, allowing the monitoring of rate of muscle fatigue, andallowing a diagnosis of muscle relationships and the subsequentstrengths and weaknesses in an athletes' makeup.

The server computer may be equipped and programmed to create a permanentrecord of the protocol data collected concerning a patient, such as bycreating CDs or DVDs or by utilizing other storage means known in theart.

The invention may be adapted to collect and to analyze electrocardiogram(“EKG”) information.

A copy of the source code for the first client computer software 114,written in the LabVIEW language and recorded on a CD ROM, is attachedhereto and incorporated by reference herein.

Although this invention has been described and illustrated by referenceto specific embodiments, it will be apparent to those skilled in the artthat various changes and modifications may be made which clearly fallwithin the scope of this invention. The present invention is intended tobe protected broadly within the spirit and scope of the appended claims.

1. An apparatus for generating neuromuscular profile data for a patient,the apparatus comprising: an EMG device for generating an EMG signal fora patient; a ROM device for generating a ROM signal for a patient, saidROM device utilizing a remote sensing technology; a signal processingunit including a ROM signal processing device for converting the ROMsignal into ROM data and a signal processing device for converting theEMG signal to EMG data the signal processing unit further including afirst data output terminal for outputting the EMG data and a second dataoutput terminal for outputting the ROM data, the first data outputterminal being separately provided in the signal processing unit fromthe second data output terminal; a client computer having a computermemory, said client computer being operatively connected to said EMGdevice and said ROM device via said signal processing unit, said clientcomputer being configured to receive said EMG data and said ROM data andto store said EMG data and said ROM data in said computer memory; and aserver computer including an expert system configured to evaluate saidEMG data and said ROM data and an expert database, the expert systemutilizing a pattern comparison method, wherein: in the patterncomparison method, the server computer is configured to extract patternsfrom said EMG data and said ROM data and to compare the extractedpatterns with patterns in the expert database, and the client computeris configured to receive said ROM data output from the second dataoutput terminal via a channel different from a channel for receivingsaid EMG data output from the first data output terminal.
 2. Theapparatus of claim 1, wherein said remote sensing technology comprises apulsed DC electromagnetic field technology, an AC electromagnetic fieldtechnology or an optical technology.
 3. The apparatus of claim 1,wherein said remote sensing technology comprises a pulsed DCelectromagnetic field technology.
 4. The apparatus of claim 3, whereinsaid ROM device utilizing the pulsed DC electromagnetic field technologycomprises a ROM transmitter and a ROM sensor, said ROM transmitteradapted to be placed in a predetermined relationship with a body of thepatient and further adapted to generate an electromagnetic field, saidROM sensor adapted to be attached to said body of the patient, said ROMsensor being adapted to generate the ROM signal in response to alocation of said ROM sensor within said electromagnetic field.
 5. Theapparatus of claim 1, further comprising: an isometric functionmeasurement device for generating an isometric function signal for thepatient, wherein: said client computer is operatively connected to saidisometric function measurement device via the signal processing device.the signal processing device converts the isometric function signal toisometric function data, and said client computer is configured toreceive said isometric function data output from the first data outputterminal and to store said isometric function data in said computermemory.
 6. The apparatus of claim 1, further comprising: a grip strengthmeasurement device for generating a grip strength signal for thepatient, wherein: said client computer is operatively connected to saidgrip strength measurement device via the signal processing device, thesignal processing device converts the grip strength signal to gripstrength data, and said client computer is configured to receive saidgrip data output from the first data output terminal and to store saidgrip data in said computer memory.
 7. The apparatus of claim 1, furthercomprising: a finger pinch measurement device for generating a fingerpinch signal for the patient, wherein: said client computer isoperatively connected to said finger pinch measurement device via thesignal processing device, the signal processing device converts thefinger pinch signal to finger pinch data, and said client computer isconfigured to receive said finger pinch data output from the first dataoutput terminal and to store said finger pinch data in said computermemory.
 8. The apparatus of claim 1, further comprising: an image inputdevice for generating video information, wherein: said client computeris operatively connected to said image input device, and said clientcomputer is configured to receive said video information and to storesaid video information in said computer memory.
 9. The apparatus ofclaim 1, further comprising: a protocol stored in said computer memory;said protocol comprising an instruction for a task to be performed bythe patient, said protocol further comprising a specification forprotocol data to be collected during performance of said task by thepatient, wherein said client computer is configured to collect and torecord said protocol data to said computer memory.
 10. The apparatus ofclaim 9, wherein: said protocol data relates to one or more of said EMGdata, said ROM data, isometric function data, grip data, pinch data orvideo information.
 11. The apparatus of claim 10, wherein said clientcomputer is configured to provide to a user said instruction for saidtask to be performed by the patient.
 12. The apparatus of claim 1,wherein: the server computer is configured to receive said EMG and ROMdata via a computer network, the server computer is configured tocompare said EMG data and ROM data with the expert database forgenerating a patient profile, and the server is further configured tosend the patient profile to the client computer.
 13. An apparatus forgenerating neuromuscular profile data for a patient, the apparatuscomprising: a signal conditioning and conversion circuit board; an EMGsensor configured to be attached to the patient at a predetermined EMGsensor location, said EMG sensor being configured to generate an EMGsignal, said EMG sensor being electrically connected to said signalconditioning and conversion circuit board, said signal conditioning andconversion circuit board being configured to receive said EMG signal andto convert said EMG signal into EMG data, and said conditioning andconversion circuit board including a first output terminal foroutputting the EMG data; a ROM transmitter configured to be placed in apredetermined transmitter location with respect to the patient and togenerate an electromagnetic field; a ROM sensor configured to beattached to a body of the patient at a predetermined ROM sensor locationand to interact with said electromagnetic field to generate a ROMsignal; a ROM signal processor electrically connected to said ROMsensor, said ROM signal processor being configured to receive said ROMsignal and to convert said ROM signal to ROM data, and said ROM signalprocessor including a second output terminal for outputting the ROMdata, the second output terminal being provided separately from thefirst terminal; a client computer having a computer memory, said clientcomputer being electrically connected to said signal conditioning andconversion circuit board and to said ROM signal processor, and saidcomputer being configured to receive said EMG data and said ROM data andto store said EMG data and said ROM data in said computer memory; and aserver computer including an expert system configured to evaluate saidEMG data and said ROM data and an expert database, the expert systemutilizing a pattern comparison method, wherein: in the patterncomparison method, the server computer is configured to extract patternsfrom said EMG data and said ROM data and to compare the extractedpatterns with patterns in the expert database, and the client computeris configured to receive said ROM data output from the second dataoutput terminal via a channel different from a channel for receivingsaid EMG data output from the first data output terminal.
 14. Theapparatus of claim 13, wherein: the server computer is configured toreceive said EMG and ROM data via a computer network, the servercomputer is configured to compare said EMG data and ROM data with theexpert database for generating a patient profile, and the server isfurther configured to send the patient profile to the client computer.15. The apparatus of claim 13, further comprising: an isometric functionsensor configured to generate an isometric function signal in responseto a force applied by the patient, said isometric function sensor beingelectrically connected to said signal conditioning and conversioncircuit board, said signal conditioning and conversion circuit boardbeing configured to convert said isometric function signal intoisometric function data, and said client computer being configured toreceive said isometric function data output from the first data outputterminal and to store said isometric function data in said computermemory.
 16. The apparatus of claim 15, further comprising: a gripstrength sensor configured to generate a grip signal in response to agrip of the patient, said grip strength sensor being electricallyconnected to said signal conditioning and conversion circuit board, saidsignal conditioning and conversion circuit board being configured toconvert said grip strength signal into grip data, and said clientcomputer being configured to receive said grip data output from thefirst data output terminal and to store said grip data in said computermemory.
 17. The apparatus of claim 16, further comprising: a fingerpinch strength sensor configured to generate a pinch strength signal inresponse to a finger pinch of the patient, said pinch strength sensorbeing electrically connected to said signal conditioning and conversioncircuit board, said circuit board being configured to convert saidfinger pinch strength signal into pinch data, and said client computerbeing adapted to receive said pinch data output from the first dataoutput terminal and to store said pinch data in said computer memory.18. The apparatus of claim 17, further comprising: a video cameraconfigured to generate video information of the patient, said videocamera being electrically connected to said client computer, said clientcomputer being configured to receive said video information from saidsignal conditioning and conversion circuit board and to store said videoinformation in said computer memory.
 19. The apparatus of claim 13,further comprising: a protocol, said protocol being resident in saidcomputer memory of said client computer; said protocol comprising aninstruction for a task to be performed by the patient, said protocolfurther comprising a specification for protocol data to be collectedduring performance of said task by the patient, said client computerbeing configured to administer said protocol and to collect saidprotocol data.
 20. The apparatus of claim 19, wherein said protocol datacomprises one or more of said EMG data, said ROM data, isometricfunction data, grip data, pinch data or video information.
 21. Theapparatus of claim 20, wherein said client computer is configured toprovide to a user said instruction for said task to be performed by thepatient.
 22. A method for collecting neuromuscular data for a patient,the method comprising the steps of: generating an EMG signal for thepatient; generating a ROM signal for the patient, said ROM data beinggenerated using a remote sensing technology; converting the EMG signalinto EMG data and outputting the EMG data from a first data outputterminal; converting the ROM signal into ROM data and outputting the ROMdata from a second data output terminal, the second output terminalbeing provided separately from the first terminal; receiving the ROMdata output from the second data output terminal via a channel differentfrom a channel for receiving the EMG data output from the first dataoutput terminal; storing said EMG data and said ROM data in a computermemory; comparing said EMG data and said ROM data by utilizing an expertsystem including an expert database, said expert database associating aprofile with said combination of said EMG data and said ROM data, theexpert system utilizing a pattern comparison method; evaluating said EMGdata and ROM data by consulting said expert database for generating aprofile for said patient; and communicating to a user said profile forsaid patient, wherein in the step of comparing, patterns are extractedfrom said EMG data and said ROM data and the extracted patterns arecompared with patterns in the expert database.
 23. The method of claim22, wherein said remote sensing technology is selected from the groupconsisting of a pulsed DC electromagnetic field technology, an ACelectromagnetic field technology and an optical technology.
 24. Themethod of claim 23, wherein said remote sensing technology comprises apulsed DC electromagnetic field technology.
 25. The method of claim 24,further comprising the steps of: generating functional capacity data forthe patient; and recording said functional capacity data in saidcomputer memory.
 26. The method of claim 25, wherein said functionalcapacity data comprises pinch data, grip data and isometric functiondata.